Don’t Take Your Vitamins!

Daniel Patrick Moynihan once said, “Everyone is entitled to their own opinion, but not to their own facts”.

But he didn’t live in the modern age of internet 3.0.

Thanks to Google founders Larry Page and Sergey Brin, we now have so many facts available to us that anyone with an agenda can carefully select a few facts that support his case, ignore those that don’t, and write an opinion piece masquerading as scientifically accurate and unbiased reporting.

To wit: the recent NY Times article Don’t Take Your Vitamins.

The author—Dr. Paul Offit– is the latest in a long line of vitamin naysayers going back at least to Dr. Victor Herbert and including the “non-practicing” psychiatrist Stephen Barrett, whose site Quackwatch is widely believed (including by me) to be wholly supported by front groups funded by Big Pharma.

But you don’t have to attribute any ill will or malicious motives to Dr. Offit—I certainly don’t– to understand why he believes as he does. You simply have to understand that he’s been taught the Gospel according to Pharmaceutical medicine, and he buys it—hook, line, and sinker. And there are enough facts lying around—i.e. someone dies of iron poisoning, massive doses of selenium can kill you—for him to bolster a case for a position he already believes in and on which, for him, they jury is no longer out.

So let’s look at the facts Dr. Offit reports.

He mentions a twenty year old study on beta carotene given to smokers. Yes, that study did show a slightly increased risk of cancer in these folks, but the lesson taken from that is that people with highly diseased lungs should not take high doses of this particular antioxidant, especially not in the synthetic form used in the study.

To conclude from this that people should not take antioxidants is akin to saying that because a step aerobics class is a really bad idea for people with broken legs, people shouldn’t exercise.

The other studies Dr. Offit quotes are all epidemiological.

Epidemiological Studies vs. Randomized Controlled Clinical Trials

Epidemiology is the stepchild of serious scientific research. As I discussed in an article on the Huffington Post, an epidemiological study bears exactly zero resemblance to a randomized controlled clinical trial. In a controlled clinical study, you do an experiment with matched groups of subjects in which one group gets the “treatment” and one gets a placebo.

Epidemiological studies, on the other hand, simply look at massive amounts of data from massive amounts of people and see what goes with what. People who take vitamins might also be people who exercise a lot, or who eat lots of vegetables, or, conversely, are very sick and believe they could get better by taking vitamins. One study from—of all places—the Journal of the American Dietetic Association, found that adults who use vitamins differ substantially in many ways from non-users, including in nutrient intake adequacy and dietary attitudes.

Epidemiology never—repeat, never—shows cause and effect, it shows associations, correlations.

We do not know why those associations are there, and in fact epidemiology is meant to generate hypotheses that can then be tested. (The hypothesis that vitamin E increases the risk of death doesn’t pass the smell test as a hypothesis, but no matter—it’s never been tested experimentally.)

Epidemiological studies were not meant to be the basis of public health policy or recommendations. After all, there’s a strong statistical association between television set ownership and diabetes prevalence. Should we assume televisions cause diabetes?

“Big T” Truth vs. “Little t” Truth

Dr. Ottis’ article illustrates the difference between what the great Gestalt philosopher Max Wertheimer called “big T” truth and “little t” truth.

Little t truths are verifiable facts which could not in any sense be said to be untrue”, but they miss the big picture. Big T truth is the “real” truth in that it contains context—it’s a fuller presentation of what’s really going on. It’s true that during the 2004 campaign, Barrack Obama said the words, “….if we keep talking about the economy, we’re going to lose”. It’s also true that the full statement was this: “John McCain said, ‘If we keep talking about the economy, we’re going to lose”.

Dr. Ottis presents little t truths—the beta carotene experiment, for example—but none of the context.

Dr. Ottis believes that we should get all our vitamins from foods, ignoring the copious evidence that supplementation can make a big difference to a lot of people. Three examples follow.

A well-controlled, large study conducted between 1983 and 1993 found that selenium supplementation (200 mcg a day) significantly diminished total cancer mortality by 52% compared to controls.
The ARED and ARED-2 studies both found that an antioxidant formula containing such antioxidants as zinc, vitamin E, vitamin C played a major role in helping people at high risk for developing age-related macular degeneration keep their remaining vision.
And, since Dr. Ottis apparently considers epidemiological evidence good science, how about the epidemiological evidence that multivitamin use is associated with longer telomere length among women? (Telomere length has long been considered a marker of biological aging.)

Dangerous and Irresponsible

The title of Dr. Ottiss’ article—“Don’t Take Your Vitamins”– is unfortunate, as it leaves confused readers with the idea that vitamins and supplements are dangerous substances that we take only because we are naive about their effects.

Millions of people will read it and decide that their omega-3’s, for example, are doing them no good and may even be harming them, despite literally thousands of studies showing the exact opposite.

In fact, just recently the Bellagio Report—which I wrote about in my blog clearly concluded that too much consumption of omega-6 and not enough consumption of omega-3 was one of the two major health issues of our time. Yet according to Dr. Ottis we shouldn’t take our “vitamins” and that would, for most people certainly include omega-3’s.

It would also include multiple vitamins, which for many people is the primary way they get the 400-800 mcg of folic acid they need to protect against neural tube birth defects. And with survey after survey showing widespread vitamin D deficiency, and with vitamin D fortified foods one of the poorest ways to get vitamin D, the message that we should not “take our vitamins” is irresponsible to say the least.

Selective Reporting at Its Worst

I mentioned earlier that Dr. Ottis was selective in his reporting of the facts, leaving the reader with the impression that vitamins were dangerous and the studies he quoted were just mere examples of the widespread dangers he warns us against. Let’s look at a few other facts he neglected to mention:

There was not even one death caused by a dietary supplement in 2008, according to the most recent information collected by the U.S. National Poison Data System.

The new 174-page annual report of the American Association of Poison Control Centers, published in the journal Clinical Toxicology shows…

zero deaths from multiple vitamins
zero deaths from any of the B vitamins
zero deaths from vitamins A, C, D, or E
zero deaths from any other vitamin

Contrast that with…

If I were to write an article quoting those studies, and a few other cases of people being clearly harmed by a prescription drug, with the title, “Don’t Take Your Prescription Drugs!”, would the NY Times publish it?

I doubt it.

It would be terrible science.